论文部分内容阅读
目的 :前瞻性观察普乐可复 (FK5 0 6 )治疗Ⅳ型狼疮性肾炎 (LN)的临床疗效及作用特点。 方法 :9例尿蛋白 >2 0g/2 4h、血尿、肾功能正常的活动性Ⅳ型LN患者 ,均给予FK5 0 6治疗 ,FK5 0 6起始剂量 0 1mg/(kg·d)。同时给予激素 ,7例患者予甲基强的松龙静脉滴注。疗效分为完全缓解 (指尿蛋白 <0 4g/2 4h ,无活动性尿沉渣 ,血清白蛋白 >35g/L ,肾功能正常 ,抗 dsDNA抗体阴性 ) ;无效 (指尿蛋白下降值小于基础值 5 0 % ,血清白蛋白≤ 30g/L ,尿RBC >4 0万 /ml)及部分缓解 (指介于完全缓解与无效之间 )。 结果 :9例患者FK5 0 6治疗 6～ 12个月 ,无一例退出治疗。 7例获得完全缓解 ,2例部分缓解 ,达到完全缓解的治疗时间 2～ 5 (3 7± 1 1)个月。血清白蛋白水平升高迅速 ,经治疗 1月 ,9例患者中 8例血清白蛋白已升至正常。治疗 3个月和 6个月后分别有 3例、7例患者尿蛋白完全转阴。治疗后 ,血清抗dsDNA抗体及冷球蛋白均降至正常。 6例患者在治疗 6个月时行重复肾活检 ,结果示肾小球细胞性新月体、袢坏死、微血栓、核碎裂消失 ,内皮下大量免疫复合物沉积明显减少。狼疮活动性指数由 10 9± 2 1下降为 3 3± 1 0 (P <0 0 5 )。 4例患者在治疗初期血肌酐可逆性升高 ,2例并发带状疱疹 ,发生高糖血症、?
OBJECTIVE: To prospectively observe the clinical efficacy and clinical characteristics of leuprolide (FK506) in the treatment of type IV lupus nephritis (LN). Methods: Nine patients with active type Ⅳ LN with urinary protein> 20g / 24h, hematuria and normal renal function were treated with FK506, and the initial dose of FK506 was 0 1mg / (kg · d). At the same time give hormones, 7 patients were given methylprednisolone intravenously. Efficacy is divided into complete remission (referring to urinary protein <0 4g / 2 4h, no activity of urine sediment, serum albumin> 35g / L, normal renal function, anti-dsDNA antibody negative); 50%, serum albumin ≤ 30 g / L, urine RBC> 40 000 / ml) and partial remission (between complete remission and ineffectiveness). Results: Nine patients were treated with FK5 06 for 6-12 months. No patient was withdrawn from treatment. Seven patients achieved complete remission and two patients achieved partial remission. The time to complete remission was 2 to 5 (37 ± 11) months. Serum albumin levels rose rapidly, after treatment in January, 9 patients in 8 cases of serum albumin has risen to normal. Three months after treatment and 6 months after treatment, urinary protein was completely negative in 7 patients. After treatment, serum anti-dsDNA antibody and cryoglobulin were normalized. Six patients underwent repeat renal biopsy at 6 months. The results showed glomerular cellular crescents, necrosis, microthrombus and nuclear fragmentation disappeared, and the deposition of a large number of immune complexes in the endothelium was significantly reduced. The lupus activity index decreased from 10 9 ± 21 to 33 ± 10 (P <0 05). Four patients had reversible elevation of serum creatinine in the early stages of treatment, and two were complicated by herpes zoster and developed hyperglycemia.